The Prime Minister:
I hope that, when the leaders of the Northern Ireland parties take the proposals back to their parties, they will find that they command support. The next stage is a consultation with the community in Northern Ireland, and that is for the Northern Ireland Executive themselves to trigger. I hope that, in addition to the legislation being passed in the Northern Ireland Assembly, the community consultation will yield the ability of the Northern Ireland parties to have a cross-community vote and to go ahead with the devolution of policing and justice. I believe that we in this Parliament will do everything in our power to make that possible, with legislation that would necessarily come to this House, but it is now for the parties of Northern Ireland to respond to the proposals that we have made. I have seen from the speech made this morning by the First Minister of Northern Ireland, and from the response of 21 Oct 2009 : Column 912
the Deputy First Minister, that they are ready to move forward now that the financial proposals have been agreed.

Q11. [294246] Mr. Gary Streeter (South-West Devon) (Con):
Given that teachers' pay is set nationally, can the Prime Minister explain why Devon schools received £375 per pupil less than the national average? Will he look again at the funding formula and bring to an end this discrimination against children educated in the rural south?

The Prime Minister:
I am happy to look at the hon. Gentleman's question in relation to his constituency, but perhaps he would look at the bigger issue. If his party goes ahead and cuts education dramatically, not just his constituency but every constituency would be affected. At some point, the Conservative party has to face up to the fact that it is ready to cut Sure Start, cut educational expenditure in schools, cut the capital building programme, cut education maintenance allowances and, of course, cut away all help for the unemployed. They have been wrong on the recession and they are going to be wrong on the recovery.

Ms Katy Clark (North Ayrshire and Arran) (Lab):
The Prime Minister will be well aware of the long campaign to get employment rights for temporary and agency workers. Will he indicate when we are going to get that legislation on the statute book?

The Prime Minister:
A consultation period has started. I gather it finishes in the next few weeks, and then we will make the final decisions.

Q12. [294247] Tim Farron (Westmorland and Lonsdale) (LD):
The Government's cancer reform strategy states that no cancer patient should live further than 45 minutes' travelling distance from their nearest cancer treatment unit. Yet in my constituency, no cancer patient lives within 45 minutes' travelling distance of the nearest cancer unit, in Preston. We as a local community are campaigning to bring a cancer unit to our hospital in Kendal. Will the Prime Minister agree to meet cancer patients, myself and local NHS workers to ensure that we get a cancer unit in Kendal as a matter of urgency?

The Prime Minister:
The Secretary of State for Health will be happy to meet the hon. Gentleman, but he knows that these decisions are made by local clinicians, not by central Government. We have made proposals to bring diagnostic services nearer the community, so that people may not in future have to travel to hospital for their diagnosis and care. That is something that we have proposed should be introduced in future years, but again, that depends on our willingness to fund the capital investment in the national health service, which I hope the hon. Gentleman will support.

21 Oct 2009 : Column 913

Points of Order

12.33 pm

Mr. Denis MacShane (Rotherham) (Lab):
On a point of order, Mr. Speaker.

Mr. Speaker:
The right hon. Member, who is an immensely experienced Member, knows that points of order come later. [Interruption.] Denis,I am wrong. [Interruption.] Order. I say to the House that I am wrong.

Mr. MacShane:
Even Homer can nod, Mr. Speaker. There are reports in the papers this week that an e-mail of this House was used to alter the Wikipedia entry of the leader of the British Conservatives in the European Parliament in order to remove references to his membership of what the chief rabbi of Poland called "a neo-Nazi party". I would like you to ask whether it is possible for the House computer authorities to investigate this matter, and either make a statement or place a report in the Library, because no e-mail of this House should be used to whitewash away any massacre of Jews by anyone in support of neo-Nazi organisations in Europe.

Mr. Speaker:
May I say to the right hon. Gentleman that I was wrong, but I am afraid that he is wrong, too, which I say in all solemnity. I recognise that he feels extremely strongly about this matter and he has put his views on the record several times-doubtless he will do so again-but I am afraid that that is not a point of order, but a point of debate.

Mr. David Drew (Stroud) (Lab/Co-op):
On a point of order, Mr. Speaker. Just before the recess, the Department for Children, Schools and Families and the Secretary of State in person announced an inquiry into Gloucestershire county council, and in particular its relationship with national challenge schools. On Monday of this week, one of my schools, the Vale of Berkeley college, was announced for closure. As yet, I have not seen the report from Mr. Badman. I have asked both the DCSF and the local authority for a copy of the full report. Given that you, Mr. Speaker, protect Back Benchers, will you as a matter of urgency look into why that report has yet to be made available?

Mr. Speaker:
I am afraid that that also is not a point of order, and I have a hunch that the hon. Member for Stroud (Mr. Drew), as an experienced and assiduous attender, is well aware of that fact. However, he has firmly registered his views on the matter, on the record, and I feel sure that those on the Treasury Bench will have heard what he has to say. If there are no further points of order, perhaps we can move on to the next business.

21 Oct 2009 : Column 914

Local Health Services and Democratic Involvement

Motion for leave to introduce a Bill (Standing Order No. 23)

12.35 pm

Dr. John Pugh (Southport) (LD):
I beg to move,

That leave be given to bring in a Bill to require Primary Care Trusts to obtain prior approval for their spending plans; to require Primary Care Trusts to present an annual spending plan to certain local authorities for approval; to provide resolution arrangements in the event of Primary Care Trusts failing to secure the consent of the relevant local authority; and for connected purposes.

Judging by the Bill's placing in the parliamentary timetable, I harbour few illusions about the odds on it making it to the statute book, unless fellow Members, or you, Mr. Speaker, are so impressed-clearly, you are not-by its obvious merit as to vary existing procedure. However, my Bill encapsulates a huge issue in this and the past few Parliaments: the democratic deficit in the NHS-the local NHS.

The local NHS is a huge taxpayer-funded service, affects everyone, is important to everyone, but is sadly totally remote from democratic decision making. Those who take the trouble to get elected to secure a mandate can make decisions about who goes to jail, who goes to war, who is taxed, who has power and who does not. We can make decisions about people's daily behaviour: what they may say, whom they may marry, what they may buy and sell, where they may smoke and what, but not about what happens in the local NHS in their area. Those decisions are made by enlightened quangos or trusts, and they are usually a combination of medical experts and appointees who may or may not bring relevant expertise with them. They decide what drugs are available, which hospitals or hospital departments stay open, where services are, how GPs and dentists shape up, and what after-hours care exists. All those issues mean a lot to some people part of the time, and much to all people most of the time.

MPs can protest at the actions of such bodies, as I did when my town lost its children's A and E service. We can plead for their intervention, as when we cajoled them into producing plans for a minor injuries unit. We can present petitions, and express concerns. But the thought of allowing anyone who has gone through the sordid process of getting elected anywhere near decision making has given successive Governments the vapours, and has been resisted hook, line and sinker, much to the satisfaction of hospital chief executives and health service managers.

Afraid to speak their minds, Ministers and mandarins have offered instead various sops. There were the community health councils-well-understood sounding boards, but bolshie enough to get abolished. There were PALS-patient advice and liaison service-the short-lived, worthy but ineffectual feedback collector. Now there are the mysteriously named and constructed LINks-local involvement networks. All were set up by successive pieces of legislation with the function of scrutinising, informing, listening, collating, airing and hearing, involving and consulting-anything, but never deciding.

All that is done on the mistaken assumption that the general public are too stupid to notice that they have absolutely no power over what happens in their local 21 Oct 2009 : Column 915
NHS. When an MP raises in this place decisions that their constituents oppose, and tasks a Minister about it, time and again the Minister, with almost comic sincerity, in Pontius Pilate fashion, says, "This is a matter for local decision making," as though "local decision making" implied that local people-outside the quango circle-had any part in it.

That is a perversion of democracy, but it satisfies the professionals, who like the prescription and genuinely fear the alternative-democratic accountability. It would be refreshing if Ministers said what is on their, or the Department of Health's, mind-what they really thought, but dare not say. What they think is that democratic decision making would lead to unworkable populism, that expert government is better than public governance, and possibly that the calibre of those elected is not up to the job-they may be too stupid or ill informed, even though many of the elected reappear on health quangos as appointees wearing different hats. They really think that this public service wants no genuine, local public voice-that that way madness lies. If a Minister actually said that, such a refreshing overt, clear declaration would flush out this argument for the fatuous nonsense that it is.

Democratically elected representatives can only espouse naked unthinking populism-which is what is feared-when they do not have to pick up the tab, run the budget or bear the consequences. Democratic bodies put up taxes, impose parking charges, change refuse arrangements, declare war, cut benefit and close facilities. I see no reason why they cannot make tough decisions, and no evidence to support that view. Democratic bodies also make a host of very technical decisions, competently, when aided by good professional advice.

For the reasons that I have given-solid and good reasons-the Liberal Democrats are very comfortable with the idea of elected health boards. We believe in removing appointees who have been whisked smugly, or in some cases humbly, into power because they have impressed some other appointee who has previously been whisked smugly or humbly into power, and replacing 21 Oct 2009 : Column 916
them with elected individuals who have had to impress the citizens served by the local trust, who gain community support and approval, and who, ultimately, justify their position to the people whom they serve.

My Bill is simply a bridge to that position. It involves even less change, and uses existing institutions. I propose that primary care trusts, as currently constituted, lay before the health scrutiny committees of existing councils, as currently constituted, their annual plans and their big decisions-not for scrutiny or consultation, but for approval, agreement and amendment. I propose a kind of democratic lock on the local NHS: a move beyond mere consultation. I propose a genuine redistribution of power from one existing institution to another existing, established institution. This is such a good idea that I believe that the model has already been embraced voluntarily in some areas.

There are likely to be disputes of substance between the PCTs and the health scrutiny committees. There are likely to be sharp differences on how to commit existing resources, given that resources are always limited. The PCT may suggest that maternity services be decommissioned, and the tribunes of the people-the council-may object. What one wants, the other may regard as plain unsafe. The Bill therefore contains a resolution procedure including, eventually, a reference upwards to the Secretary of State as a last resort.

I genuinely see no reason why this model cannot work-in fact, it does work- and produce not simply good decisions, but good decisions with a popular mandate. That would be nice. Our NHS could be reclaimed, without micro-management or meddling, and not with government by experts but with popular government, expertly informed.

Bill read the First time; to be read a Second time on Friday 23 October and to be printed (Bill 152).

21 Oct 2009 : Column 917

Speaker's Statement

12.44 pm

Mr. Speaker:
Before we move to the main business-the Opposition day motion in the name of the Liberal Democrats-I have a very brief and, I hope, pertinent statement to make.

I am grateful to the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg) for raising on a point of order on Monday the question of whether Members who have incurred losses with Equitable Life can vote on the first motion today.

As in previous debates on Equitable Life, any Members speaking in the debate should follow the advice of the Registrar of Members' Financial Interests dating back to 2003 and declare their interests, whether or not they are formally registrable.

In relation to voting, I can only repeat the words of Mr. Speaker Weatherill in January 1986 in relation to members of Lloyd's:

"In matters of public policy, it has been the long-standing practice of the House-originally formulated as far back as 1811 by Mr. Speaker Abbot-that there is no obligation on an hon. Member to refrain from voting on a matter of public policy."-[ Official Report, 14 January 1986; Vol. 89, c. 1013.]

I appreciate that that does not solve the right hon. and learned Gentleman's problem-that, without speaking in the debate, he cannot put on the record his interest when voting-but he has himself done so by raising this as a point of order.

21 Oct 2009 : Column 918

Opposition Day

[19th allotted day]

Equitable Life

[Relevant Documents: The Second Report from the Public Administration Select Committee, on Justice Delayed: The Ombudsman's report on Equitable Life, HC 41, and the Government response, HC 953; and the Sixth Report from t he Committee, on Justice denied? The Government's response to the Ombudsman's report on Equitable Life, HC 219, and the Government response, HC 569 .]

12.45 pm

Dr. Vincent Cable (Twickenham) (LD):
I beg to move,

That this House notes that the Parliamentary Ombudsman has taken the unusual step of using powers under the 1967 Act to present Parliament with a further and final report on Equitable Life; also notes that the Public Administration Select Committee's Sixth Report, Justice denied? The Government's response to the Ombudsman's report on Equitable Life, concluded that the Government response to the Parliamentary Ombudsman's report was inadequate as a remedy for injustice; recognises the vital role the Ombudsman plays in public life; reaffirms the duty of Parliament to support the office of the Ombudsman; believes the Government should accept the recommendations of the Ombudsman on compensating policyholders who have suffered loss; notes the outcome of the Judicial Review announced on 15 October extending the period for compensation claims back to 1991; welcomes the formation of the All-Party Group on Justice for Equitable Life Policyholders; and notes with regret its necessary formation and the fact that over 30,000 people have already died waiting for a just resolution to this saga.

I have no interest to declare. Indeed, I am not only moving this motion for disinterested reasons, but moving it on behalf of more than my own party-although we feel strongly about it. Members in all parts of the House have taken up the cause of Equitable Life policyholders, and in fact the basis of this motion is early-day motion 1423, which has been signed by the remarkably large number of 337 Members, including 113 of the Government party. This motion should therefore have widespread all-party support, and the only amendment to it that has been tabled is a purely factual one; it notes that a judicial review has taken place, but makes no comment or judgment on the outcome.

There is a lot of detail-legal, actuarial and other kinds-in this argument and we shall be plunged into it before long, but I want to start by setting out the broad principles that underlie the motion. From our point of view, there are two essential concerns. One of them is a human concern-a concern for human welfare and the individuals who have lost from this disaster-and the other is a constitutional concern. The human concern derives from the fact that there are roughly 1 million Equitable Life policyholders. About 400,000 policies are still managed by Equitable Life, while the other 600,000 are managed by other insurance companies. Many of those people have suffered large losses-up to half of their pension. Of those 1 million, about 30,000 have died since the original collapse of the company. Since the ombudsman reported on the subject, about 6,000 have died, and every day that passes before justice is obtained another 15 die. That summarises, in rather graphic terms, the consequences of leaving injustice unremedied.